Endophthalmitis Workup

Updated: Apr 06, 2015
  • Author: Daniel J Egan, MD; Chief Editor: Robert E O'Connor, MD, MPH  more...
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Workup

Laboratory Studies

The most important laboratory study for endophthalmitis is Gram stain and culture of the aqueous and vitreous obtained by the ophthalmologist.

Real-time polymerase chain reaction (RT-PCR) has improved diagnostic results over traditional culture. [17]

For endogenous endophthalmitis, other laboratory studies that may be performed include the following:

  • Complete blood count with differential - Evaluating for signs of infection, elevated white count, left shift
  • Erythrocyte sedimentation rate - Evaluating for rheumatic causes, chronic infections, or malignancy. The ESR is often normal in cases of endophthalmitis.
  • Blood urea nitrogen - Evaluating for renal failure or patients at increased risk
  • Creatinine - Evaluating for renal failure or patients at increased risk
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Imaging Studies

Imaging studies include the following:

  • Chest radiograph - Evaluating for source of infection
  • Cardiac ultrasound - Evaluating for endocarditis as source of infection
  • CT scan/MRI of orbit - May help rule out other entities in the differential diagnosis
  • Ocular ultrasound – Helpful when positive findings are seen, such as low-amplitude mobile echoes, vitreous membranes, and thickening of the retina and choroid; however, sensitivity is not high enough to rule out the diagnosis with a negative ultrasound [2, 18]
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Other Tests

Other tests include the following:

  • Blood cultures - Evaluating for source of infection
  • Urine culture - Evaluating for source of infection
  • Other cultures depending on clinical signs or symptoms
    • Cerebrospinal fluid - Evaluating for source of infection
    • Throat culture - Evaluating for source of infection
    • Stool - Evaluating for source of infection
    • Indwelling intravascular catheter tip - Evaluating for source of infection
    • A culture of the penetrating object, if available, can be a valuable resource.
    • Vitreous culture obtained by the ophthalmologist
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Procedures

Ophthalmological evaluation includes the following:

  • Check visual acuity
  • Examine both eyes by slit lamp biomicroscopy
  • Intraocular pressure
  • Dilated funduscopy
  • Possible ultrasonography if fundus not well visualized (This will help determine if a retained intraocular foreign body is present, the density of the vitreitis, and if the retina is attached or not.)
  • Routine cultures should include aerobic, anaerobic, and fungal cultures.
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